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Akinlotan M, Chen B, Fontanilla TM, Chen Fan V. Community Dent Oral Epidemiol 2018; 46: 38–46

Only 13 papers were identified for this meta-analysis of the cost effectiveness of fissure sealants to prevent, or reduce the incidence of, dental caries. The lack of sufficient numbers and of consistent outcome measures were major hindrances to comparison between studies. The authors recognise that cost effectiveness of sealant placement is a narrow measure of effectiveness, limited as it is to immediate benefits to teeth. There is no recognition of the longer term health gains, such as a reduction in the need for emergency dental care and increased school attendance, and its impact on overall health and life span.

Despite these limitations the studies show that 'always sealing primary molars appeared to be the most effective strategy, whereas risk-based sealing was the optimal strategy with differing caries risk'. Sealants delivered in a school setting were as effective as those delivered in a clinic setting.